Similar presentations

2 Why is this a problem?The Late Preterm Infant (LPTI) population has increased by 30% since the 1980’s and accounts for as much as 75% of all preterm births in the US.Possibly due to increasing maternal age, increased use of fertility treatments, multiple gestation, increasing obesity rates, maternal morbidity.One study reports that a cost of $51,600 is associated with each late preterm birth.EB

3 Physical Exam FindingsLPTI should essentially have a normal exam, but may have some of these variations:Increased lanugo, increased vernix, thin appearing skin, more visible veinsBoys may have high rising testes and a smoother appearing scrotumGirls may have more prominent labia minoraEB

4 Physical Exam FindingsDecreased creases on soles of feetLack of fully developed cartilage in earDecreased subcutaneous fatMay have decreased tone, with resting tone not in flexed positionMost of the differences between a full term and late preterm infant are things you can’t see during a routine physical exam!EB

10 Physiologic Challenges: BreathingDevelopment of terminal air sacs in the lungs continues in utero during weeks /7.Alveoli are maturing and becoming lined with Type 1 epithelial cells. These cells are closer in proximity to capillaries to help with gas exchange.Type 2 cells develop during this time also to secrete surfactant.Immaturity can lead to poor lung compliance and increased pulmonary resistance.EB

12 Respiratory DistressUsually manifests in first hours after birth with grunting, flaring, tachypnea, retractions.Risk increases if c-section delivery with no labor.During labor, catecholamines are released which help with absorption of lung fluid and surfactant release helping to improve lung compliance.EB

14 Physiologic Challenges: Energy and MetabolismRegulation of temperature helps minimize risk of hypoglycemiaAll babies have physiologic nadir of blood sugar between 1-2 hours of life. This decrease in blood sugar is more pronounced in the late preterm than full term infant.Should have blood sugars monitored and have first feeding within 1 hour of life (if stable) and no less than every 3 hours afterEB

15 Physiologic Challenges: HypoglycemiaLPTI 3x more likely to suffer from hypoglycemia than term infants.Decreased glycogen stores and adipose tissueImmature liver enzymes less able to increase glucose production through gluconeogenesisImmature pancreatic beta cells may secrete more insulin than necessaryMedical complications increasing demand.EB

16 HypoglycemiaSources vary as to what is a ‘normal’ glucose in infants. Reported ranges: to80% of total glucose is consumed by the brainLPTIs cannot effectively use other forms of fuel such as ketones, amino acids, and glycerol to raise blood sugar.This, combined with immature protective systems in the brain, make the LPTI more at risk for adverse neurologic outcomes related to hypoglycemia.LPTIs can use lactate as an alternate source.EB

23 Physiologic Challenges: Immature Nervous SystemSignificant brain growth and maturation occurs in last 6-8 weeks of pregnancy34 weeker has 50% less brain volume than term infantLPTI less able to control state regulation and regulate internal processes.Decreased tone, positional apnea, disorganized suck/swallow/breathe, frequent startling, more spitting up, unpredictable response to stimuli (even when attempting to soothe)Minimizing or clustering stimulation is helpfulEB

24 Physiologic Challenges: Immature Nervous SystemBecause of the significant amount of brain growth, neuronal connections to be made, and overall nervous system development that still is occuring, the LTPI is at a higher risk for long term neurodevelopmental delays.In severe cases, IVH and PVL, although this is not commonEB

28 LPTI Discharge Considerations: Suggestions from the AAPDemonstrate weight gainCompetent feeding by parents preferred methodAble to maintain body temperature while dressed in open crib with normal room tempStable cardiorespiratory functionParents educated on special needs of LPTI and competent in all carePCP identified and close follow up arrangedEB